Clinical Research Of Enteral Nutrition On Dixon Operation In Elderly Patients With Rectal Cancer Merger Of Constipation

Purpose:Among patients with rectal cancer incidence in elderly patients withrectal cancer rate is high(60~80%). The relatively high rate ofmisdiagnosis. The course is relatively prolonged. More complicationsafter the operation and generally eat late. These patients are mostly poornutritional status, the need for nutritional support. Elderly patients withrespiratory or circulatory system disease were high. Clinical nutritionprinciple for as long as the patients with intestinal have enough functionsshould take enteral nutrition. How this kind of patients after operationtreatment can make the patients recovery of gastrointestinal function assoon as possible. Improve the immune status of patients, reduce thepostoperative complications and ensure the stability of the nutritionalsupport is an unavoidable problem. To study the clinical effect of earlyapplication of small dosage enternal nutrition combined with parenteralnutrition in elderly patients with rectal carcinoma after Dixon operationinstead of conventional parenteral nutrition. Effect on the postoperative complications and the exhaust time.Method:This study enrolled30rectal cancer patients in the colorectaldepartment of First Hospital of Jilin University from June1,2011toOctober30,2012.It contained13males and17females aged from60to80(mean71.2). All the patients underwent classical Dixon operation andhad eupepsia. All patients without metabolic disease and no digestivetract malformation. Patients with normal gastrointestinal function accompanied by symptoms of constipation. Patients without congenitaldiseases and surgery without preoperative chemotherapy. No intestinalobstruction and without all or part of the colon resection. The patientswas divided into two groups(A and B). A group received early enteralnutrition combined with small dose of parenteral nutrition support; GroupB was the control group, and enteral nutrition according to conventionalparenteral nutrition to exhaust. Operation before the routine examinationof prealbumin, albumin, hemoglobin, lymphocyte count four indicators.On the existence of malnourished patients by infusion of blood plasmaand albumin preparations to correct malnutrition. Operation of bowelpreparation before the same standards. By two ways of nasogastric andnasointestinal tube infusion of enteral nutrition preparation. Three daysafter surgery according to the patient in a gradual increase in the amountof injection pump, In group A, all patients had no obvious abdominal distension symptoms first exhaust extraction of gastrointestinaldecompression of oral intake. Group B patients after the simpleapplication of parenteral nutrition support for patients, without obviousabdominal distension symptom extraction exhaust and gastrointestinaldecompression of oral intake. Then recorded the postoperativecomplications as abdominal distension, abdominal pain, vomiting etc. theexhaust time and tested the nutritive indexes in third and seventh daysafter the operation.Results:There was no death in each group. There were2patients(13.3%) ingroup A endured postoperative complications as abdominal distension；but There were5patients(33.33%) in group B endured postoperativecomplications as abdominal distension. Compared with group A1case(6.67%) in group B suffered anastomotic fistula which healed withconservative management. There were3patients(20%) suffered delayedhealing of operative incision in group B；while only1(6.67%) in group A.statistical significance(P＜0.01) was observed. After the operationthe exhaust time was68.43±23.05h in group A; in group B it was108.67±43.37h statistical significance(P＜0.01). Third days after operation, Agroup has been three per minute to five times of bowel sounds were80%,66.7%of patients have exhaust. B group has been three per minute to fivetimes of bowel sounds were26.7%,20%of patients have exhaust.Seventh days after operation, A group has been heard and normal bowel sounds were100%,100%of patients have exhaust. The B group has beenheard and normal bowel sounds were80%,86.7%of patients haveexhaust.There was no statistical significance in nutritive indexes on the daybefore the operation and in third days after the operation. Seventh daysafter the operation nutrition, statistical significance(P＜0.01) wasobserved in prealbumin lymphocyte count. But there was no statisticalsignificance（P＞0.05） in albumin and hemoglobulin between the twogroups.Conclusion:Early application of small dosage enternal nutrition combined withparenteral nutrition in elderly patients with rectal carcinoma after Dixonoperation could supply a more stable and safe support than conventionalnutrition support method to postoperative patients of Dixon bymaintaining normal immunity, decreasing postoperative complicationsand shortening length of stay. It could shorten the exhaust time afteroperation, accelerate the recovery of gastrointestinal function. It couldalso adjust the mental state of patients to a more stable and positivedirection to help reduce the incidence of complications after operation.